Surgical Site Infection (SSI) Event potx

January 2013 9-1 Procedure-associated Events SSI Surgical Site Infection (SSI) Event Introduction: In 2010, an estimated 16 million operative procedures were performed in the United States. 1 A recent prevalence study found that SSIs were the most common healthcare-associated infection, accounting for 31% of all HAIs among hospitalized patients. 2 NHSN data for 2006-2008 (16,147 SSIs following 849,659 operative procedures) showed an overall SSI rate of 1.9%. 3 While advances have been made in infection control practices, including improved operating room ventilation, sterilization methods, barriers, surgical technique, and availability of antimicrobial prophylaxis, SSIs remain a substantial cause of morbidity and an associated mortality rate of 3% has been attributed to them. 4 Of this, 75% of the mortality rate has been directly related to the SSI. 4 Surveillance of SSI with feedback of appropriate data to surgeons has been shown to be an important component of strategies to reduce SSI risk. 5,6,7,8 A successful surveillance program includes the use of epidemiologically-sound infection definitions and effective surveillance methods, stratification of SSI rates according to risk factors associated with SSI development, and data feedback. 6,7 Recommendations are outlined in the CDC’s Guideline for Prevention of Surgical Site Infection, 1999. 8 Settings: Surveillance of surgical patients will occur in any inpatient and/or outpatient setting where the selected NHSN operative procedure(s) are performed. Requirements: Perform surveillance for SSI following at least one NHSN operative procedure category (Table 1) as indicated in the Patient Safety Monthly Reporting Plan (CDC 57.106). Collect SSI (numerator) and operative procedure category (denominator) data on all procedures included in the selected procedure categories for at least one month. A procedure must meet the NHSN definition of an operative procedure in order to be included in the surveillance. SSI monitoring requires active, patient-based, prospective surveillance. Post-discharge and ante- discharge surveillance methods should be used to detect SSIs following inpatient and outpatient operative procedures. These methods include 1) direct examination of patients’ wounds during follow-up visits to either surgery clinics or physicians’ offices, 2) review of medical records or surgery clinic patient records, 3) surgeon surveys by mail or telephone, and 4) patient surveys by mail or telephone (though patients may have a difficult time assessing their infections). Any combination of these methods is acceptable for use; however, CDC criteria for SSI must be used. To minimize Infection Preventionists’ (IPs) workload of collecting denominator data, operating room data may be downloaded (see file specifications at: http://www.cdc.gov/nhsn/PDFs/ImportingProcedureData_current.pdf). An SSI will be associated with a particular NHSN operative procedure and the facility in which that procedure was performed. Refer to the NHSN application’s Help system for instruction on linking an SSI to an operative procedure. January 2013 9-2 Procedure-associated Events SSI The International Classification of Diseases, 9 th Revision Clinical Modifications (ICD-9-CM) codes, which are defined by the ICD-9 Coordination and Maintenance Committee of the National Center for Health Statistics and the Centers for Medicare and Medicaid Services (CMS), are developed as a tool for classification of morbidity data. The wide use enables the grouping of surgery types for the purpose of determining SSI rates. ICD-9-CM codes are updated annually in October and NHSN operative procedure categories are subsequently updated and changes shared with NHSN users. Table 1 lists NHSN operative procedure category groupings by ICD-9-CM codes. Because ambulatory surgery centers and hospital outpatient surgery departments may not use ICD-9-CM procedure codes, Table 1 provides Current Procedural Terminology (CPT) code mapping for certain NHSN operative procedure categories to assist users in determining the correct NHSN code to report for outpatient surgery cases. However, CPT codes do not take precedence over ICD-9-CM codes when determining the appropriate NHSN operative procedure category for inpatient surgery cases. Table 1 also includes a general description of the types of operations contained in the NHSN operative procedure categories. Definitions: An NHSN operative procedure is a procedure • that is performed on a patient who is an NHSN inpatient or an NHSN outpatient; and • takes place during an operation (defined as a single trip to the operating room [OR] where a surgeon makes at least one incision through the skin or mucous membrane, including laparoscopic approach, and closes the incision primarily* before the patient leaves the OR); and • that is included in Table 1. *Primary closure is defined as closure of all tissue levels, regardless of the presence of wires, wicks, drains, or other devices or objects extruding through the incision. However, regardless of whether anything is extruding from the incision, if the skin edges are not fully reapproximated for the entire length of the incision (e.g., are loosely closed with gaps between suture/staple points), the incision is not considered primarily closed and therefore the procedure would not be considered an operation. In such cases, any subsequent infection would not be considered an SSI, although it may be an HAI if it meets criteria for another specific infection site (e.g., skin or soft tissue infection). NHSN Inpatient: A patient whose date of admission to the healthcare facility and the date of discharge are different calendar days. NHSN Outpatient: A patient whose date of admission to the healthcare facility and date of discharge are the same calendar day. Operating Room (OR): A patient care area that met the Facilities Guidelines Institute’s (FGI) or American Institute of Architects’ (AIA) criteria for an operating room when it was constructed or renovated. 9 This may include an operating room, C-Section room, interventional radiology room, or a cardiac catheterization lab. January 2013 9-3 Procedure-associated Events SSI Table 1. NHSN Operative Procedure Category Mappings to ICD-9-CM Codes and CPT Codes CPT codes are to be used for outpatient surgery cases only. Legacy Code Operative Procedure Description ICD-9-CM Codes / CPT Codes AAA Abdominal aortic aneurysm repair Resection of abdominal aorta with anastomosis or replacement 38.34, 38.44, 38.64 AMP Limb amputation Total or partial amputation or disarticulation of the upper or lower limbs, including digits 84.00-84.19, 84.91 APPY Appendix surgery Operation of appendix (not incidental to another procedure) 47.01, 47.09, 47.2, 47.91, 47.92, 47.99 AVSD Shunt for dialysis Arteriovenostomy for renal dialysis 39.27, 39.42 BILI Bile duct, liver or pancreatic surgery Excision of bile ducts or operative procedures on the biliary tract, liver or pancreas (does not include operations only on gallbladder) 50.0, 50.12, 50.14, 50.21-50.23, 50.25, 50.26, 50.29, 50.3, 50.4, 50.61, 50.69, 51.31-51.37, 51.39, 51.41-51.43, 51.49, 51.51, 51.59, 51.61-51.63, 51.69, 51.71, 51.72, 51.79, 51.81-51.83, 51.89, 51.91- 51.95, 51.99, 52.09, 52.12, 52.22, 52.3, 52.4, 52.51-52.53, 52.59- 52.6, 52.7, 52.92, 52.95, 52.96, 52.99 BRST Breast surgery Excision of lesion or tissue of breast including radical, modified, or quadrant resection, lumpectomy, incisional biopsy, or mammoplasty 85.12, 85.20-85.23, 85.31-85.36, 85.41-85.48, 85.50, 85.53-85.55, 85.6, 85.70-85.76, 85.79, 85.93- 85.96 19101, 19112, 19120, 19125, 19126, 19300, 19301, 19302, 19303, 19304, 19305, 19306, 19307, 19316, 19318, 19324, 19325, 19328, 19330, 19340, 19342, 19350, 19355, 19357, 19361, 19364, 19366, 19367, 19368, 19369, 19370, 19371, 19380 CARD Cardiac surgery Procedures on the heart; includes valves or septum; does not include coronary artery bypass graft, surgery on vessels, heart transplantation, or pacemaker implantation 35.00-35.04, 35.06, 35.08, 35.10- 35.14, 35.20-35.28, 35.31-35.35, 35.39, 35.42, 35.50, 35.51, 35.53, 35.54, 35.60-35.63, 35.70-35.73, 35.81-35.84, 35.91-35.95, 35.98- 35.99, 37.10-37.12, 37.31-37.33, 37.35-37.37, 37.41, 37.49, 37.60 January 2013 9-4 Procedure-associated Events SSI Legacy Code Operative Procedure Description ICD-9-CM Codes / CPT Codes CEA Carotid endarterectomy Endarterectomy on vessels of head and neck (includes carotid artery and jugular vein) 38.12 CBGB Coronary artery bypass graft with both chest and donor site incisions Chest procedure to perform direct revascularization of the heart; includes obtaining suitable vein from donor site for grafting 36.10-36.14, 36.19 CBGC Coronary artery bypass graft with chest incision only Chest procedure to perform direct vascularization of the heart using, for example the internal mammary (thoracic) artery 36.15-36.17, 36.2 CHOL Gallbladder surgery Cholecystectomy and cholecystotomy 51.03, 51.04, 51.13, 51.21-51.24 47480, 47562, 47563, 47564, 47600, 47605, 47610, 47612, 47620 COLO Colon surgery Incision, resection, or anastomosis of the large intestine; includes large-to- small and small-to-large bowel anastomosis; does not include rectal operations 17.31-17.36, 17.39, 45.03, 45.26, 45.41, 45.49, 45.52, 45.71-45.76, 45.79, 45.81-45.83, 45.92-45.95, 46.03, 46.04, 46.10, 46.11, 46.13, 46.14, 46.43, 46.52, 46.75, 46.76, 46.94 44140, 44141, 44143, 44144, 44145, 44146, 44147, 44150, 44151, 44160, 44204, 44205, 44206, 44207, 44208, 44210 CRAN Craniotomy Excision repair, or exploration of the brain or meninges; does not include taps or punctures 01.12, 01.14, 01.20-01.25, 01.28, 01.29, 01.31, 01.32, 01.39, 01.41, 01.42, 01.51-01.53, 01.59, 02.11- 02.14, 02.91-02.93, 07.51-07.54, 07.59, 07.61-07.65, 07.68, 07.69, 07.71, 07.72, 07.79, 38.01, 38.11, 38.31, 38.41, 38.51, 38.61, 38.81, 39.28 CSEC Cesarean section Obstetrical delivery by Cesarean section 74.0, 74.1, 74.2, 74.4, 74.91, 74.99 FUSN Spinal fusion Immobilization of spinal column 81.00-81.08 January 2013 9-5 Procedure-associated Events SSI Legacy Code Operative Procedure Description ICD-9-CM Codes / CPT Codes FX Open reduction of fracture Open reduction of fracture or dislocation of long bones with or without internal or external fixation; does not include placement of joint prosthesis 79.21, 79.22, 79.25, 79.26, 79.31, 79.32, 79.35, 79.36, 79.51, 79.52, 79.55, 79.56 23615, 23616, 23630, 23670, 23680, 24515, 24516, 24538, 24545, 24546, 24575, 24579, 24586, 24587, 24635, 24665, 24666, 24685, 25337, 25515, 25525, 25526, 25545, 25574, 25575, 25607, 25608, 25609, 25652, 27236, 27244, 27245, 27248, 27254, 27269, 27283, 27506, 27507, 27511, 27513, 27514, 27535, 27536, 27540, 27758, 27759, 27766, 27769, 27784, 27792, 27814, 27822, 27826, 27827, 27828 GAST Gastric surgery Incision or excision of stomach; includes subtotal or total gastrectomy; does not include vagotomy and fundoplication 43.0, 43.42, 43.49, 43.5, 43.6, 43.7, 43.81, 43.82, 43.89, 43.91, 43.99, 44.15, 44.21, 44.29, 44.31, 44.38-44.42, 44.49, 44.5, 44.61- 44.65, 44.68-44.69, 44.95-44.98 HER Herniorrhaphy Repair of inguinal, femoral, umbilical, or anterior abdominal wall hernia; does not include repair of diaphragmatic or hiatal hernia or hernias at other body sites 17.11-17.13, 17.21-17.24, 53.00- 53.05, 53.10-53.17, 53.21, 53.29, 53.31, 53.39, 53.41-53.43, 53.49, 53.51, 53.59, 53.61-53.63, 53.69 49491, 49492, 49495, 49496, 49500, 49501, 49505, 49507, 49520, 49521, 49525, 49550, 49553, 49555, 49557, 49560, 49561, 49565, 49566, 49568, 49570, 49572, 49580, 49582, 49585, 49587, 49590, 49650, 49651, 49652, 49653, 49654, 49655, 49656, 49657, 49659, 55540 HPRO Hip prosthesis Arthroplasty of hip 00.70-00.73, 00.85-00.87, 81.51- 81.53 27125, 27130, 27132, 27134, 27137, 27138, 27236, 27299 HTP Heart transplant Transplantation of heart 37.51-37.55 January 2013 9-6 Procedure-associated Events SSI Legacy Code Operative Procedure Description ICD-9-CM Codes / CPT Codes HYST Abdominal hysterectomy Abdominal hysterectomy; includes that by laparoscope 68.31, 68.39, 68.41, 68.49, 68.61, 68.69 58150, 58152, 58180, 58200, 58210, 58541, 58542, 58543, 58544, 58548, 58570, 58571, 58572, 58573, 58951, 58953, 58954, 58956 KPRO Knee prosthesis Arthroplasty of knee 00.80-00.84, 81.54, 81.55 27438, 27440, 27441, 27442, 27443, 27445, 27446, 27447, 27486, 27487 KTP Kidney transplant Transplantation of kidney 55.61, 55.69 LAM Laminectomy Exploration or decompression of spinal cord through excision or incision into vertebral structures 03.01, 03.02, 03.09, 80.50, 80.51, 80.53, 80.54*, 80.59, 84.60-84.69, 84.80-84.85 LTP Liver transplant Transplantation of liver 50.51, 50.59 NECK Neck surgery Major excision or incision of the larynx and radical neck dissection; does not include thyroid and parathyroid operations 30.1, 30.21, 30.22, 30.29, 30.3, 30.4, 31.45, 40.40-40.42 NEPH Kidney surgery Resection or manipulation of the kidney with or without removal of related structures 55.01, 55.02, 55.11, 55.12, 55.24, 55.31, 55.32, 55.34, 55.35, 55.39, 55.4, 55.51, 55.52, 55.54, 55.91 OVRY Ovarian surgery Operations on ovary and related structures 65.01, 65.09, 65.12, 65.13, 65.21- 65.25, 65.29, 65.31, 65.39, 65.41, 65.49, 65.51-65.54, 65.61-65.64, 65.71-65.76, 65.79, 65.81, 65.89, 65.92-65.95, 65.99 PACE Pacemaker surgery Insertion, manipulation or replacement of pacemaker 00.50-00.54, 17.51, 17.52, 37.70- 37.77, 37.79-37.83, 37.85-37.87, 37.89, 37.94-37.99 PRST Prostate surgery Suprapubic, retropubic, radical, or perineal excision of the prostate; does not include transurethral resection of the prostate 60.12, 60.3, 60.4, 60.5, 60.61, 60.69 PVBY Peripheral vascular bypass surgery Bypass operations on peripheral arteries 39.29 January 2013 9-7 Procedure-associated Events SSI Legacy Code Operative Procedure Description ICD-9-CM Codes / CPT Codes REC Rectal surgery Operations on rectum 48.25, 48.35, 48.40, 48.42, 48.43, 48.49-48.52, 48.59, 48.61-48.65, 48.69, 48.74 RFUSN Refusion of spine Refusion of spine 81.30-81.39 SB Small bowel surgery Incision or resection of the small intestine; does not include small-to-large bowel anastomosis 45.01, 45.02, 45.15, 45.31-45.34, 45.51, 45.61-45.63, 45.91, 46.01, 46.02, 46.20-46.24, 46.31, 46.39, 46.41, 46.51, 46.71-46.74, 46.93 SPLE Spleen surgery Resection or manipulation of spleen 41.2, 41.33, 41.41-41.43, 41.5, 41.93, 41.95, 41.99 THOR Thoracic surgery Noncardiac, nonvascular thoracic surgery; includes pneumonectomy and hiatal hernia repair or diaphragmatic hernia repair (except through abdominal approach) 32.09, 32.1, 32.20-32.23, 32.25, 32.26, 32.29, 32.30, 32.39, 32.41, 32.49, 32.50, 32.59, 32.6, 32.9, 33.0, 33.1, 33.20, 33.25, 33.28, 33.31-33.34, 33.39, 33.41-33.43, 33.48, 33.49, 33.98, 33.99, 34.01- 34.03, 34.06, 34.1, 34.20, 34.26, 34.3, 34.4, 34.51, 34.52, 34.59, 34.6, 34.81-34.84, 34.89, 34.93, 34.99, 53.80-53.84 THYR Thyroid and/or parathyroid surgery Resection or manipulation of thyroid and/or parathyroid 06.02, 06.09, 06.12, 06.2, 06.31, 06.39, 06.4, 06.50-06.52, 06.6, 06.7, 06.81, 06.89, 06.91-06.95, 06.98, 06.99 VHYS Vaginal hysterectomy Vaginal hysterectomy; includes that by laparoscope 68.51, 68.59, 68.71, 68.79 VSHN Ventricular shunt Ventricular shunt operations, including revision and removal of shunt 02.21, 02.22, 02.31-02.35, 02.39, 02.42, 02.43, 54.95 † XLAP Exploratory laparotomy Abdominal operations not involving the gastrointestinal tract or biliary system; includes diaphragmatic hernia repair through abdominal approach 53.71, 53.72, 53.75, 54.0, 54.11, 54.12, 54.19, 54.3, 54.4, 54.51, 54.59, 54.61, 54.63, 54.64, 54.71- 54.75, 54.92, 54.93 *If the 80.54 procedure was a percutaneous repair of the anulus fibrosus, it is not considered an NHSN operative procedure and should not be included in LAM denominator data. † Include only if this procedure involves ventricular shunt (i.e., is not a Ladd procedure to repair malrotation of intestines). January 2013 9-8 Procedure-associated Events SSI For a complete list of all ICD-9-CM codes mapped to their assignment as an NHSN operative procedure category, a surgical procedure other than an NHSN operative procedure (OTH), or a non- operative procedure (NO), see ICD-9-CM Procedure Code Mapping to NHSN Operative Procedure Categories at http://www.cdc.gov/nhsn/XLS/ICD-9-cmCODEScurrent.xlsx. ASA score: Assessment by the anesthesiologist of the patient’s preoperative physical condition using the American Society of Anesthesiologists’ (ASA) Classification of Physical Status. 10 Patient is assigned one of the following which may be used as one element of SSI risk adjustment: 1. Normally healthy patient 2. Patient with mild systemic disease 3. Patient with severe systemic disease that is not incapacitating 4. Patient with an incapacitating systemic disease that is a constant threat to life 5. Moribund patient who is not expected to survive for 24 hours with or without the operation. NOTE: If coded as expired or as organ donor, report as ASA = 5. Duration of operative procedure: The interval in hours and minutes between skin incision and primary skin closure. See also definition of primary closure and the Denominator Data reporting instructions in this chapter. Emergency operative procedure: A nonelective, unscheduled operative procedure. Emergency operative procedures are those that do not allow for the standard immediate preoperative preparation normally done within the facility for a scheduled operation (e.g., stable vital signs, adequate antiseptic skin preparation, colon decontamination in advance of colon surgery, etc.). General anesthesia: The administration of drugs or gases that enter the general circulation and affect the central nervous system to render the patient pain free, amnesic, unconscious, and often paralyzed with relaxed muscles. Scope: An instrument used to visualize the interior of a body cavity or organ. In the context of an NHSN operative procedure, use of a scope involves creation of several small incisions to perform or assist in the performance of an operation rather than use of a traditional larger incision (i.e., open approach). Robotic assistance is considered equivalent to use of a scope for NHSN SSI surveillance. See also Instructions for Completion of Denominator for Procedure Form and both Numerator Data and Denominator Data reporting instructions in this chapter. Trauma: Blunt or penetrating injury. Wound class: An assessment of the degree of contamination of a surgical wound at the time of the operation. Wound class should be assigned by a person involved in the surgical procedure, e.g., surgeon, circulating nurse, etc. The wound class system used in NHSN is an adaptation of the American College of Surgeons wound classification schema 8 . Wounds are divided into four classes: Clean: An uninfected operative wound in which no inflammation is encountered and the respiratory, alimentary, genital, or uninfected urinary tracts are not entered. In addition, clean January 2013 9-9 Procedure-associated Events SSI wounds are primarily closed and, if necessary, drained with closed drainage. Operative incisional wounds that follow nonpenetrating (blunt) trauma should be included in this category if they meet the criteria. NOTE: The following NHSN operative procedure categories are NEVER considered to have a clean wound classification: APPY, BILI, CHOL, COLO, REC, SB, and VHYS. Clean-Contaminated: Operative wounds in which the respiratory, alimentary, genital*, or urinary tracts are entered under controlled conditions and without unusual contamination. Specifically, operations involving the biliary tract, appendix, vagina, and oropharynx are included in this category, provided no evidence of infection or major break in technique is encountered.*Includes female and male reproductive tracts. Contaminated: Open, fresh, accidental wounds. In addition, operations with major breaks in sterile technique (e.g., open cardiac massage) or gross spillage from the gastrointestinal tract, and incisions in which acute, nonpurulent inflammation is encountered are included in this category. Dirty or Infected: Includes old traumatic wounds with retained devitalized tissue and those that involve existing clinical infection or perforated viscera. This definition suggests that the organisms causing postoperative infection were present in the operative field before the operation. Table 2. Surgical Site Infection Criteria Criterion Surgical Site Infection (SSI) Superficial incisional SSI Must meet the following criterion: Infection occurs within 30 days after any NHSN operative procedure, including those coded as ‘OTH’* and involves only skin and subcutaneous tissue of the incision and patient has at least one of the following: a. purulent drainage from the superficial incision. b. organisms isolated from an aseptically-obtained culture of fluid or tissue from the superficial incision. c. superficial incision that is deliberately opened by a surgeon and is culture-positive or not cultured and patient has at least one of the following signs or symptoms: pain or tenderness; localized swelling; redness; or heat. A culture negative finding does not meet this criterion. d. diagnosis of a superficial incisional SSI by the surgeon or attending physician. *http://www.cdc.gov/nhsn/XLS/ICD-9-cmCODEScurrent.xlsx January 2013 9-10 Procedure-associated Events SSI Comments There are two specific types of superficial incisional SSIs: 1. Superficial Incisional Primary (SIP) – a superficial incisional SSI that is identified in the primary incision in a patient that has had an operation with one or more incisions (e.g., C-section incision or chest incision for CBGB) 2. Superficial Incisional Secondary (SIS) – a superficial incisional SSI that is identified in the secondary incision in a patient that has had an operation with more than one incision (e.g., donor site incision for CBGB) REPORTING INSTRUCTIONS • Do not report a stitch abscess (minimal inflammation and discharge confined to the points of suture penetration) as an infection. • Do not report a localized stab wound or pin site infection as SSI. While it would be considered either a skin (SKIN) or soft tissue (ST) infection, depending on its depth, it is not reportable under this module. • Diagnosis of “cellulitis”, by itself, does not meet criterion d for superficial incisional SSI. • If the superficial incisional infection extends into the fascial and/or muscle layers, report as a deep incisional SSI only. • An infected circumcision site in newborns is classified as CIRC. Circumcision is not an NHSN operative procedure. CIRC is not reportable under this module. • An infected burn wound is classified as BURN and is not reportable under this module. Deep incisional SSI Must meet the following criterion: Infection occurs within 30 or 90 days after the NHSN operative procedure according to the list in Table 3 and involves deep soft tissues of the incision (e.g., fascial and muscle layers) and patient has at least one of the following: a. purulent drainage from the deep incision. b. a deep incision that spontaneously dehisces or is deliberately opened by a surgeon and is culture-positive or not cultured and patient has at least one of the following signs or symptoms: fever (>38°C); localized pain or tenderness. A culture-negative finding does not meet this criterion. c. an abscess or other evidence of infection involving the deep incision that is found on direct examination, during invasive procedure, or by histopathologic examination or imaging test. d. diagnosis of a deep incisional SSI by a surgeon or attending physician. Comments There are two specific types of deep incisional SSIs: 1. Deep Incisional Primary (DIP) – a deep incisional SSI that is identified [...]... procedure category(s) are monitored for signs of SSI The Surgical Site Infection (SSI) form is completed for each such patient found to have an SSI If no SSI events are identified during the surveillance month, check the “Report No Events” field in the Missing PA Events tab of the Incomplete/Missing List The Instructions for Completion of the Surgical Site Infection form include brief instructions for collection... 1992;13(10):599-605 7 Haley RW, Culver DH, White JW, Morgan WM, Emori TG, Munn VP The efficacy of infection surveillance and control programs in preventing healthcare-associated infections in US hospitals Am J Epidemiol 1985;121:182-205 8 Centers for Disease Control and Prevention Guideline for prevention of surgical site infection, 1999 Infect Control Hosp Epidemiol 1999;20(4):247-278 9 Facilities Guidelines... Malangoni MA, Anderson-Teschendorf MJ Effectiveness of a surgical wound surveillance program Arch Surg 1983;118:303-7 6 Society for Healthcare Epidemiology of America, Association for Professionals in Infection Control and Epidemiology, Centers for Disease Control and Prevention, Surgical Infection Society Consensus paper on the surveillance of surgical wound infections Infect Control Hosp Epidemiol 1992;13(10):599-605... healthcare-asociated infections in acute care facilities Infect Control Hospital Epidemiol 2012;33(3):283-91 3 Yi M, Edwards JR, et al Improving risk-adjusted measures of surgical site information for the National Healthcare Safety Network Infect Control Hosp Epidemiol 2011; 2(10):970-986 4 Awad SS Adherence to Surgical Care Improvement Project Measures and post-operative surgical site infections Surg Infect... has an infection in the organ/space being operated on in the INSTRUCTIONS first 2-day period of hospitalization and the surgical incision was closed primarily, subsequent continuation of this infection type during the remainder of the surveillance period is considered an organ/space SSI, if January 2013 9-11 Procedure-associated Events SSI • • • • • January 2013 organ/space SSI and site- specific infection. .. subsequent incisional infection is considered an SSI • Post-op patient has skin condition (e.g., dermatitis, blister, impetigo) near intact incision, and then subsequently develops incisional infection within the follow-up surveillance period; this is an SSI • Patient has remote site infection, either prior to or after an operation, or has a manipulation that “seeds” operative site (e.g., dental work),... procedure types January 2013 9-13 Procedure-associated Events SSI Table 4 Specific Sites of an Organ/Space SSI Criteria for these sites can be found in the NHSN Help system (must be logged in to NHSN) or the HAI Definitions chapter Code Site Code Site BONE Osteomyelitis JNT Joint or bursa BRST Breast abscess or mastitis LUNG Other infections of the respiratory tract CARD Myocarditis or pericarditis MED Mediastinitis... superficial and deep incisional sites as deep incisional SSI Classify infection that involves superficial incisional, deep incisional, and organ/space sites as deep incisional SSI This is considered a complication of the incision Organ/Space SSI Must meet the following criterion: Infection occurs within 30 or 90 days after the NHSN operative procedure according to the list in Table 3 and infection involves any... therapeutic purposes, organ/space infection can occur In such a case, if organ/space infection develops during the 90-day surveillance period, the infection is not attributed to the operation in which the implant was inserted; instead it should be attributed to the latter procedure January 2013 9-15 Procedure-associated Events SSI 9 Reporting Instructions for Specific Post-operative Infection Scenarios: • Once... procedure and therefore if an organ/space infection develops, it is considered an SSI However, if the stoma site becomes infected, it is considered skin or soft tissue infection, not an SSI 6 SSI Detected at Another Facility: If an SSI is detected at a facility other than the one in which the operation was done, notify the IP of the index facility with enough detail so the infection can be reported to NHSN . 2. Surgical Site Infection Criteria Criterion Surgical Site Infection (SSI) Superficial incisional SSI Must meet the following criterion: Infection. January 2013 9-1 Procedure-associated Events SSI Surgical Site Infection (SSI) Event Introduction: In 2010, an estimated 16 million